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Meeting the Needs of Patients AND Providers

One of the earliest questions during the Flip the Clinic design meeting in September was, Why? Why Flip the Clinic? One participant suggested that patients are often satisfied with their care, but feel like everyone care is lacking. Another pointed out that for both patient and provider the existing system had a huge benefit: inertia. So was there really a reason to suggest change?

By noon we had an answer—well over 100 of them, in fact.

In an exercise, the meeting’s attendees identified all the needs of patients — and all the needs of providers — that are currently unmet. Needs of patients were scribbled on yellow Post-it notes; the needs of providers were written on blue. When the brainstorming wrapped up, each small group was asked to present their Post-its publicly.

As they were presented, each unmet need was grouped by theme, and some surprising patterns appeared. In several cases, the unmet needs of patients and providers were mirror images: Both groups, for instance, want more control during the doctor/patient encounter. In other cases, the patient and provider’s interests were aligned; the desire for more time popped up a lot. And then there were surprises: quality of life was all over the board, but not only in the patient category, but for providers as well. The desire for joy among providers seemed particularly poignant.

By the end, the results blanketed the entire white board, the Post-its providing a striking display of all that could be improved. “It drives home why we’re here thinking about these things,” remarked one participant. “This is just not acceptable. We need to find other alternatives.”

Here’s the list of unmet needs in its entirety:

Access to resources
– Patients: to specialists, to resources for patients, community connection

Support
– Patients: from health providers, assistance in resisting the medicalization of their lives, how to focus on what matters to me as a patient, Maslow’s hierarchy—tools to address what patients know they need to be healthy reassurance

– Providers: from behavioral health, to help patients filter through their own research, navigating social media, emotional support, for demands on providers (re: charting, admin, tasks, data capture & billing), to learn how to use resources, paperwork

– Providers: to manage data input, to help make the most of data collected, air traffic control for practice, to track productivity, a way to track patient progress, actionable data, smart individual management tools

Continuity of care
– Patients: connection with providers outside of visits, patient outreach by the system (when should patients come in), a way to track patient progress, preparation and follow up, “true” care coordination, ongoing connection with provider, even between visits, continuity, reliability

– Providers: smart individual management tools, population management tools / surveillance, a way to track patient progress, to help patients filter through their own research, to better engage patient outside the clinic, Tools to better self manage outside my walls

Communication
– Patients: provider that really knows the patient, ongoing connection with provider, even between visits, to be really heard, to help patients filter through their own research, to really understand choices, to get better explanations, clarity on options and choices, to have the provider focus on what the patient is truly concerned about, to get less than acute concerns addressed, way to share social & life information, shared decision making, an actual relationship with care providers

– Providers: getting feedback from patients, colleagues

Time
– Patients: to listen, process, understand their own health issues, to ask questions, to have the provider focus on what the patient is truly concerned about, an actual relationship with care providers, to get less than acute concerns addressed

– Providers: to think deeply about what a patient needs, time for everything—quality time with patients and time to fulfill other duties, time for the things that matter the most, slave to the EMR, focus (no multitasking), flexibility

Information and training
Patients: patients are unaware of future disease risk (what is bad & how bad), lack of understanding of health care prices & costs, to understand why they’re at the doctor’s, to know their responsibilities, don’t understand the basics of health (their own anatomy)

Providers: understand patient preferences, how to deal with patients that are informed and opinionated participants in care, informed patients, in leadership (increasing shift from sole player to team leader), nutrition knowledge, strategy for embracing change, to learn how to use resources

Empathy
– Patients: from the system, their provider, to be treated as an individual, for the situation being difficult, context of patient’s life, understanding what’s happening outside of their symptoms

– Providers: for the challenges of work, community connection, seeing patients not get what they need

Control
– Patients: Not to be blamed, an appropriate balance of power and control, control, shared decision making

– Providers: challenge of being held accountable for things beyond their control, dealing with hierarchy and disrespect, control, losing authority, patients that don’t follow recovery advice, freedom from fear of liability

Empowerment
– Patients: to learn how to prioritize health, to have health agenda and questions addressed, to take responsibility for their own health, to feel more empowered, shared decision making, control, respect & “customer service”

– Providers: how to deal with patients that are informed and opinionated participants in care, engaged patients, patient participation

Cultural context
– Patients: life / cultural context, way to share social & life information

Maslow’s hierarchy—tools to address what patients know they need to be healthy

– Providers: joy, making a difference, sense of a mission, time to do what you got into health care for in the first place, sources of ownership over something bigger, intellectually challenged, inspiring mentors, creativity and stimulation, ongoing diversity of work, working with great teams

– Providers: payments and reimbursements, freedom from the constraints of what is and isn’t billable, feeling underpaid, overwhelmed by trying to understand the shifting financial realities, a way to get paid for doing the right thing